AB0267 FEATURES OF CARDIAC PATHOLOGY IN PATIENTS WITH SECONDARY OSTEOARTHRITIS ON THE BACKGROUND OF RHEUMATOID ARTHRITIS
Authors: L. Feiskhanova
Journal: Annals of the Rheumatic Diseases (2022)

Background Rheumatoid arthritis, being one of the most common rheumatic diseases, is often accompanied by systemic (extra-articular) manifestations and various complications. In particular, the inflammatory process often leads to damage to the tissues of the joint and the subsequent development of secondary arthrosis. RA is accompanied by a high cardiovascular risk. Patients with OA also have an increased risk of developing cardiovascular diseases. Objectives To identify the features of cardiac pathology in patients with rheumatoid arthritis (RA) in combination with osteoarthritis (OA). Methods The study involved 282 patients with secondary OA on the background of RA. The first group consisted of 48 patients who underwent endoprosthetics of at least one large joint due to severe OA, the second group consisted of 234 patients with RA and secondary OA of functional class 1-3 who did not require endoprosthetics. The patients underwent determination of the level of rheumatoid factor, circulating immune complexes, C-reactive protein, ESR, ECG with calculation of the QT interval variance, vectorcardiography and echocardiography. Results Patients with RA who underwent endoprosthetics due to secondary osteoarthritis were characterized by later clinical and radiological stages (p&lt;0.0001), as well as a higher functional class compared to patients of group 2 (p&lt;0.0005). Both groups differed in the level of ESR: 1st - 29 [16;40] mm/h, 2nd - 20[12.5;31] mm/h (p&lt;0.05). In other words, the severity of osteoarthritis is more associated with the inflammatory component of the underlying disease than with the autoimmune one. During the correlation analysis in group 1, the following correlations were found: inverse, average and reliable relationship between age and the E/a transmittal flow index (r=-0.63, p&lt;0.0001); direct, average relationship between the DAS level and the relative wall thickness of the left ventricle (LV) (r=0.39, p&lt;0.05); inverse, average relationship between the level of rheumatoid factor and the vectorcardiographic parameter MV-rise (r=-0.32, p&lt;0.05); direct, strong the relationship between the relative thickness of the LV wall and the area of the loop P on vectorcardiography (r=0.76, p=0.01); the inverse, average relationship between the final LV diastolic size and the loop area T (r=-0.65, p=0.03). Thus, in this group of patients, the older a person is, the more the diastolic function of the left ventricle is impaired. In this study, we found out that with an increase in the activity of the disease, the structural geometry of the heart becomes more concentric, which affects the results of vectorcardiography. In the 2nd group, a direct, average correlation was revealed between the DAS index and the value of the maximum vector according to vectorcardiography (r=0.6, p&lt;0.05); the inverse, strong relationship between the E/a of the transmittal flow and the dispersion of the QT interval (r=-0.73, p=0.02). It follows from this that in group 2, an increase in the activity of the disease is accompanied by an increase in the electrical activity of the ventricles of the heart, determined by the maximum vector. And with an increase in diastolic dysfunction of the left ventricle, there is an increase in readiness for the initiation of life-threatening arrhythmias and electrical instability of the myocardium. Conclusion In patients with RA and severe secondary OA, high activity of the disease contributes to structural and geometric remodeling of the heart, and in the milder form of secondary OA is accompanied by electrophysiological remodeling in the form of increased electrical activity of the ventricles and, accordingly, the risk of malignant arrhythmias. References [1]Mathieu S., Couderc M., Tournadre A. et al. Cardiovascular profile in osteoarthritis: a meta-analysis of cardiovascular events and risk factors // Joint Bone Spine. – 2019. – V.86, N6. – P. 665-813. [2]Michaud K., Wolfe F. Comorbidities in rheumatoid arthritis // Best Practice &amp; Research: Clinical Rheumatology. – 2007. – V.21, N5. – P. 885–906. Disclosure of Interests None declared